A panel of experts speaking at Experimental Biology 2004 reports on
new understandings of the mechanisms and pathways through which the body's
hormonal response to stress alters immune system function and influences
susceptibility, onset and exacerbation of mental and physical diseases,
including atherosclerotic heart disease, depression, infectious diseases,
and autoimmune diseases such as multiple sclerosis.

Thanks to a growing understanding of this process, scientists and clinicians
increasingly are identifying individuals' risk factors and are teaching
people - from high level executives to young children - simple coping behaviors
that can successfully buffer the effect of stress on immune function and
health.

The panel on "Alteration of Health by the Hormonal Response to Stress"
is made up of members of the PsychoNeuroImmunology Research Society. Chaired
by Dr. Bruce S. Rabin, University of Pittsburgh, the symposium is part
of the scientific sessions of The American Association of Immunologists,
one of the six sponsoring societies of Experimental Biology 2004.

How does stress create damage? Dr. William B. Malarkey, Ohio State University,
describes how the perception of stress activates the interface between
the endocrine (or hormonal) system and the immune system, initiating a
cascade of physiological events. If the perception of stress is short-term,
these hormonal changes fade away.

But if the stressful sensory input persists, the resulting dysregulation
of the immune system initiates an inflammatory state that, if not stabilized,
leads to symptoms and then established disease processes.

Many of these stress-induced inflammatory immune responses are precursors
to the chronic diseases of aging, says Dr. Malarkey.

As the immune system modifies in response to hormones produced by stress
as perceived by the brain, it produces soluble factors that affect the
brain itself. Dr. Andrew H. Miller, Emory University, describes data indicating
how this two-way interaction between the brain and immune system has a
significant impact on causing and maintaining clinical depression.

Further stressors make things worse. Scientists increasingly recognize
that stress in childhood or early life can create a hypervigilancy and
hyperresponse to stressors later in life.

This intense response to stress is associated with an increased vulnerability
to develop clinically significant depression during chronic immune stimulation,
such as occurs during immunotherapy for cancer.

The immune system also plays an important role in the onset and progression
of artherosclerotic coronary artery disease, including heart attacks.

By now, most scientists and clinicians – and many lay people – understand
that psychological factors can act as risk factors for coronary diseases.
Dr. Willem J. Kop, USUHS, explains three types of psychological risk factors
and the psychoneuroimmunolgical pathways involved in the progression of
coronary disease.

In brief, chronic psychological risk factors, such as hostility and
low-socioeconomic status, play important roles at early disease stages.
In the transition from stable to unstable atherosclerotic plaques, episodic
factors like depression and exhaustion become more important. And finally,
acute psychological triggers – mental stress and anger, for example – can
promote myocardial ischemia and plaque rupture.

Thus, he says, "the specific hormonal and immunological pathways by
which psychological factors promote heart disease change with increasing
stages of coronary atherosclerosis."

Dr. Bruce Rabin describes behaviors that help ameliorate hormonal response
to stress and how these can be taught or learned on one's own.

At the University of Pittsburgh Medical Center's Healthy Lifestyle Program,
which he directs, stress coping behaviors are taught to groups of all ages,
from all socioeconomic and educational levels, and to people with autoimmune
disease, cancer survivors, and the children of parents who have or have
survived cancer.

Techniques include deep breathing, guided imagery using CDs or scripts,
and expressive writing (15 minutes writing about a stressor, then discarding
the writing without reading it).

Dr. Rabin says that across all groups, people who utilize stress coping
behaviors report improvement in the problems they face and in many aspects
of their lives, including less depression, improved sleep patterns, enhanced
social interactions, and improved ability to be more compliant with diets
and good nutrition.

In addition to describing these and other advances in the biopsychosocial
approach to health and disease -- the usual exchange of new scientific
information that characterizes the interdisciplinary Experimental Biology
meetings, Dr. Rabin says he and other panel members believe it is important
information personally for those scientists (and journalists) at the meeting
whose own lives produce stress-related risks.